Adipocytokines and risk of stroke in older people: a nested case-control study.
BACKGROUND
Inflammation may play an important role in atherothrombosis and in promoting cerebral damage after stroke. We hypothesized that plasma adipocytokine concentrations would be associated with risk of stroke in older people.


METHODS
Nested case-control study from the Prospective Study of Pravastatin in the Elderly (PROSPER). Subjects were aged 70-82 years and followed up for a mean of 3.2 years: 266 incident stroke cases (179 confirmed as ischaemic) were compared with 532 controls matched for age, gender and treatment allocation (pravastatin or placebo). Adipocytokines [adiponectin, interleukin- (IL-)18 and tumour necrosis factor (TNF)alpha] were measured on stored baseline plasma samples.


RESULTS
Elevated plasma adiponectin was associated with lower risk of ischaemic stroke on univariate analysis: odds ratio (OR) 0.78 per 1 SD increase (95% CI 0.62-0.97). There were no associations of IL-18 or TNFalpha with risk for ischaemic or total strokes. In multivariate models the independent predictors of ischaemic stroke were prior cerebrovascular accident (OR 2.68, 95% CI 1.60-4.50), any alcohol use (1.98, 1.33-2.94), triglycerides (1.40, 1.11-1.77), Barthel score (0.75, 0.58-0.96) and known diabetes (1.72, 1.04-2.83); adiponectin, IL-18 and TNFalpha did not contribute. A similar pattern of risk was seen for total stroke.


CONCLUSIONS
Reduced adiponectin may have a modest role in the aetiology of ischaemic stroke in older people, however IL-18 and TNFalpha are unlikely to play any important part. These adipocytokines do not have clinical predictive utility; history of prior cerebrovascular accident, known diabetes mellitus, prior disability and higher alcohol intake explain much of the stroke risk.
Stott
David J
DJ
Division of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Scotland, UK. d.j.stott@clinmed.gla.ac.uk
Welsh
Paul
P
Rumley
Ann
A
Robertson
Michele
M
Ford
Ian
I
Sattar
Naveed
N
Westendorp
Rudi G J
RG
Jukema
J Wouter
JW
Cobbe
Stuart M
SM
Lowe
Gordon D O
GD
D054392:Adipokines / Q000097:blood*; D052242:Adiponectin / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D020382:Interleukin-18 / Q000097:blood; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
C499918:ADIPOQ protein, human; D054392:Adipokines; D052242:Adiponectin; D015415:Biomarkers; D020382:Interleukin-18; D014409:Tumor Necrosis Factor-alpha